Budget 2013: Reinventing healthcare in Singapore?

A recent article covering financial accessibility and sustainability of the Singapore healthcare system sparked some interesting and insightful comments from readers who felt the pre-budget 2013 period was the perfect moment to revisit a system that needs to adapt to an ageing population.

Politically-charged discussions aside, policy-makers, medical practitioners, and the general public all understand the fact that extended lifespans and changing lifestyles not only create new priorities and needs (increased number of patients, long-term treatments and hospitalisations, etc.), but also put unprecedented pressure on the current health system (rising costs, insufficient staff, etc.).

The system, which according to specialists speaking at the healthcare policy forum is already underfunded and inaccessible to many, should indeed be revised.

One commenter points out that the current “3M” system covers a good part of the most basic health treatments available, but don’t adequately protect people with long-term or high-risk afflictions: “We’ve got some pretty good subsidies for the basic stuff, but a lot more needs to be done on the heavier stuff”.

Another commenter suggests starting simple: “allow the use of Medisave for polyclinic visits. To prevent abuse, let’s cap it to 4 visits per year”. Under the current scheme, Polyclinic bills can only be paid with a Medisave account for outpatient treatment of MOH-approved list of chronic diseases of up to $400 per Medisave account per year.

Regarding the use of hybrid Medisave/Medishield models, another commenter believes “the policy should be tweaked on the use of Medisave to pay for “Enhanced” MediShield plans that provide complete coverage (…) for those who have a certain level of Medisave accumulated instead of cash payment. (…) This will encourage more to opt for such plans and ensure that more are covered effectively”.

That’s why, the commenter argues, the Medishield should be “more flexible about when people can use [it] or how much they’re allowed to draw out”. But even then, coverage should be extended both in terms of number of people and types of illnesses covered, as “insurance is not the be all and end all of the protection”.

An alternative to the reliance on long-running insurance packages would be for the government to fund “a catastrophic illness insurance scheme with all its extra money. This fund will allow patients with certain catastrophic, life-threatening illnesses (…) to access life-saving/prolonging treatments at very little/no cost, because otherwise, they will die”.

The commenter even suggests a way to determine the priority of the treatments covered by such a scheme: “treatments funded can be agreed periodically by an expert committee applying a rigorous cost-benefit evaluation weighing up expected benefit versus cost so it is less likely to go over budget (…)”.
So how would all these initiatives be funded?

Concerning the share of overall national budget dedicated to Singaporeans’ heatlh care, one of the commenters suggests cutting “defence spending by 2% and channel[ing] those funds to healthcare, particularly for the elderly”.

If the 2013 budget for defence is close to the $12.3 billion allocated to MINDEF in 2012, then just 2% would quickly and easily inject some $246 million into a system that will soon be in desperate need of a make-over.

Earlier this week the government announced a number of important measures designed to reduce Singaporeans’ share of out-of-pocket medical expenses — with the Government taking up a larger portion — and broadening insurance coverage by expanding risk-pooling.

Among the main measures are:

– expanding the usage of Medisave, primarily meant to support large hospitalisation bills;

– expanding the usage of Medifund, which covers expenses for nursing homes and other long-term care services;

– increasing investments in health promotion and preventive care;

– topping up the Senior’s Mobility and Enabling funds by S$40 million;

– topping up Medifund by S$1 billion, bringing the total fund size to S$4 billion;